Drug Therapy in Resuscitation From Electromechanical Dissociation

RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support

“…Atropine doses of greater than 0.04 mg/kg were associated with a worse outcome, and the conclusion was that atropine at higher than standard doses should be avoided in CPR. In one canine study (LOE 3, fair/opposing), dogs were asphyxiated until asystole occurred, then were randomized to be revived with saline, calcium, atropine, or methoxamine . No dogs randomized to receive atropine (0.5 mg/animal; body weight 11–25 kg) were successfully resuscitated.…”

Use of alpha‐agonists for management of anaphylaxis occurring under anaesthesia: case studies and review

“…They also showed that there was no significant difference in clinical effectiveness between epinephrine, phenylephrine, metaraminol and methoxamine [34], and claimed that agents with predominantly β‐effects were of ‘no value’. Methoxamine was later demonstrated to be twice as effective as epinephrine in resuscitation from ventricular fibrillation [36] and more effective than other drugs for resuscitation from electromechanical dissociation [37]. Redding eventually claimed that: ‘…methoxamine is the drug of choice during attempted resuscitation from cardiac arrest regardless of the ECG pattern.’ These authors, and others, concluded that the efficacy of epinephrine and other vasopressors in management of cardiac arrest lies in their α‐adrenergic properties [37, 38].…”

“…Methoxamine was later demonstrated to be twice as effective as epinephrine in resuscitation from ventricular fibrillation [36] and more effective than other drugs for resuscitation from electromechanical dissociation [37]. Redding eventually claimed that: ‘…methoxamine is the drug of choice during attempted resuscitation from cardiac arrest regardless of the ECG pattern.’ These authors, and others, concluded that the efficacy of epinephrine and other vasopressors in management of cardiac arrest lies in their α‐adrenergic properties [37, 38]. In fact, it has been demonstrated that pretreatment of dogs with α‐blockers (phenoxybenzamine) precludes the ability to obtain return of spontaneous circulation when epinephrine is used for resuscitation [39].…”

Total intravenous anaesthesia in a patient with familial hypokalaemic periodic paralysis*

“…Muscle biopsy revealed positive in vitro testing, but genetic analysis did not show one of the known mutations. A possible association of FHPP and malignant hyperthermia may be explained by: first, several mutations on chromosome 1q32 (gene map CACNL1A3) encoding for different subunits of the dihydropyridine receptor [16]; secondly, the possible interaction of an altered dihydropyridine receptor with the ryanodine receptor; and thirdly, a malignant hyperthermia-like feature due to increased cytosolic calcium in FHPP dependent on the altered dihydropyridine receptor. A possible association of FHPP and malignant hyperthermia may be explained by: first, several mutations on chromosome 1q32 (gene map CACNL1A3) encoding for different subunits of the dihydropyridine receptor [16]; secondly, the possible interaction of an altered dihydropyridine receptor with the ryanodine receptor; and thirdly, a malignant hyperthermia-like feature due to increased cytosolic calcium in FHPP dependent on the altered dihydropyridine receptor.…”